硬脑膜肥厚的MRI诊断及鉴别诊断分析

MRI diagnosis and differential diagnosis of dura mater hypertrophy

目的分析硬脑膜肥厚的MRI表现,探讨不同病理情况的影像学特点,以提高定性诊断水平。方法回顾分析36例经手术病理或临床证实的硬脑膜肥厚性疾病例纳入研究,其中男20例,女16例,年龄6～68岁,平均年龄(34±3.5)岁,采用西门子1.5T超导MR成像仪,完成横断面T2WI、T1WI、FLAIR和矢状面T2WI平扫,横断面、冠状面和矢状面T1WI增强及横断面FLAIR增强,2名高级职称影像医师共同回顾性分析MRI表现。结果低颅压综合征10例(27.8%),肥厚性硬脑膜炎10例(27.8%),其中1例为特发性,9例为感染性,硬脑膜转移瘤8例(22.2%),其中合并脑实质内小结节病灶5例,单纯局限性脑膜增厚3例,白血病颅内浸润1例(2.8%),系统性黄斑狼疮1例(2.8%),脑外伤后血肿形成2例(5.6%),脑肿瘤放疗后2例(5.6%),侵袭性脑膜瘤2例(5.6%),上述病例于MRI检查上均表现为硬脑膜弥漫性或局限性增厚。结论硬脑膜增厚疾病种类繁多,但根据病灶所发生的范围和是否伴随软脑膜及脑实质内强化结节等特征,并结合临床表现,多数能做出明确诊断。

Objective To study the MRI features of dura mater hypertrophy, to discuss the image characteristics of different pathological conditions, and to improve the diagnostic level. Methods Thirty-six patients with pathological and clinical proved dura mater hypertrophy were included in the study （20 males and 16 females, aged 6-68 years old, mean 34-3.5 years old）. Siemens h 5 T superconducting MR scanner was used. The sequence included axial T1WI T2WI and FLAIR, sagittal T2 WI, coronal axial and sagittal T~ WI enhancement and axial FLAIR enhancement. Retrospective analy sis of MRI images was done by two senior radiologists. Results 10 cases were intracranial hypotension syndrome, accountning for 27.8%, 10 cases of hypertrophic cranial pachymeningitis, accounting for 27.8%, 8 cases were meningeal carcinoma, accounting for 22.2%, 1 case was cerebral leukemia, accounting for 2.82%, 1 case was cerebral lupus, accounting for 2.82 %, 2 cases were cerebral hematoma of traumatic brain injury, accounting for 5.64 %, 2 cases were cerebral glioma after radiotherapy, accounting for 5.64%, and the last 2 cases were invasive meningioma, accounting for 5.64%. All above cases showed local or diffused meningeal enhancement on MRI with contrast enhancement, accompanying with or without small lesions of parenchyma or leptomeningeal enhancement. Conclusion Dural Hypertrophy has a wide ranges, however, according to the site of pathological changes that occur and their signal characteristics, combined with clinical manifestations and MRI enhancement mode, most cases can be made a definite diagnosis .